Amber VanBramer, a registered nurse in the ICU at Berkshire Medical Center, says who knows better than nurses what patients need. VanBramer and other RNs are rallying support of Question 1 that sets minimum nurse staffing levels.

Mark Brodeur, also an RN, was more fiery in his speech, blaming hospital executives across the state for choosing profit over patient care.

"The care has gotten tougher, the patients have gotten sicker with our opioid epidemic," said Amber VanBramer, a registered nurse in the intensive care unit at Berkshire Medical Center. "We need safe limits to be able to care for these patients properly."

Around a dozen registered nurses and supporters, including North Adams City Councilor Jason LaForest, a nurse, gathered in the light rain outside the hospital on Tuesday afternoon to gear up for canvassing with less than five weeks to the November election.

One of the biggest issues they say they're addressing is confusion over exactly what the Patient Safety Act will mean for Massachusetts.

Question 1 was placed on the ballot by petition and spells out the maximum number of patients under a nurse's charge in acute care facilities.

Voting yes will institute the changes that will have to be implemented by Jan. 1, 2019, or at the expiration of any current nursing contract. Voting no will leave everything as it is.

Safe staffing levels have been at the crux of contracts with the Massachusetts Nurses Association over the past several years and previous attempts at a ballot resolution resulted in a state law in 2014 mandating staffing level in intensive care units.

Over the past three years, the nurses at BMC have reported more than 500 incidents of what they say is unsafe staffing levels. And just the year before, the local MNA chapter had staged a vigil in the same spot to rally on the eve of a strike over contract issues including safe staffing.

"It was one of the largest collective actions we've taken in over 35 years," said Mark Brodeur, an RN at BMC. "Thousands of people in our community stood up ...

"It took years and massive public pressure for our hospital executives to act and even when they did, it fell short of what our patients need."

Berkshire Medical Center officials, along with hospital officials across the state, say forcing them to staff units according to Question 1 will cost millions of dollars, drive up costs and wait times, and endanger health systems and small rural hospitals in particular. BMC alone is looking at more than $20 million in costs to add on more nurses.

But Donna Kelly-Williams, RN and co-chair of the Committee to Ensure Safe Patient Care, dismisses those concerns.

"Every single day hospitals make choices about where they're going to put their resources," she said. "This ballot question is about putting the resources into the patient first and it does have all of the flexibility needed for any community hospital to be able to put safe patient limits in place in every hospital in Massachusetts."

"Question 1 is not a government mandate," said Brodeur. "Hospitals across the state already use staffing schedules, they already know what their own limits should be. They put out plans for how many nurses they will schedule in advance. ... There is no recourse for bedside nurses when hospitals to do not meet patient needs.

"That is why nurses like myself wrote Question 1 for our patients."

The nurses' association says minimum staffing will lead to better outcomes for patients. Nurses in charge of too many patients don't have enough time to spend at bedsides providing focused care, leading to poorer quality health care. In regard to a looming nursing shortage, they say guaranteed staffing may bring back nurses who have left the field and prevent burnout in currently overstressed nurses.

Brodeur was quick to blame hospital executives for choosing profit over patient care, but hospital officials say they are concerned about keeping both patients and health systems healthy.

"This is bigger than what the union would like you to believe, that this is just a wealthy hospital who doesn't care about their nurses or patient safety. That is just not so," Berkshire Health Systems CEO David Phelps said last week.

The fear is that a yes vote would cause nursing shortage across the region. Phelps said insurers and government reimbursements have been focused on keeping people healthy and out of the hospital, and a lot of that depends on ancillary services, such as the Brien Center and other health-care providers. If Question 1 is passed, hospital officials say the demand for nurses would further concentrate resources to the hospital, cutting back what is done outside of it.

The measures inclusion of set penalties of between $250 to $2,500 per day for noncompliance also has administrators on edge.

A BW Research Partnership and Mass Insight report, commissioned by the Massachusetts Health and Hospital Association, estimated that implementation of the law will cost the state's health-care system $1.3 billion in the first year and $900 million a year afterward, as well as "approximately $100 million in increased direct state spending in the first year." It will require nearly 6,000 registered nurses in the first month in a state that has a vacancy rate of 5.3 percent, or 1,200 nurses.

The Massachusetts Health Policy Commission is expected to release its own independent report this week on the statewide financial implications of Question 1 but advocates say there's already a good example in California.

"We're not inventing the wheel here," Kelly-Williams said. "This has already been done in California and the same rhetoric that you're hearing regarding community hospitals and closures and costs are all being exaggerated the exact same way they were in California."

She said California has lower insurance rates, better patient outcomes and more profitable health-care systems.

There are some significant differences between California's mandated minimum staffing and Question 1. First, the ballot measure passed in California in 1999 left the actual staffing quotas up to the recommendations of the state's Department of Public Health, which put them into effect in 2004. That gave hospitals more time to implement the law and have a voice in how the staffing levels were calculated during a series of public hearings.

It does appear that other positions were sacrificed to afford the number of nurses needed in California but Question 1 prevents Massachusetts hospitals from reducing their health-care workforce to hire nurses.

Meanwhile, it's not surprising there's some confusion over which way to vote on Question 1. Both sides are using very similar red, white and blue signs that can be seen along the roadways — only some signs say vote no, and others say vote yes.

"If we're going to win this we need to make sure we're knocking on doors," said Casey Pease, an emergency medical technician whose mother is a nurse. "When they hear directly from you as a nurse, you're able to help change their minds or help them stand up for Question 1."

pittsfield.com welcomes critical, respectful dialogue. Name-calling, personal attacks, libel, slander or foul language is not allowed. All comments are reviewed before posting and will be deleted or edited as necessary.

BHS' use which was designed after the Nurses' sign of the term "Nurses" is deliberately misleading and imho sleazy at best. This alone will result in my voting FOR #`1. Hospitals should revert back to being non-profits.

I also think that BHS colluded with and was a big reason that the full service North Adams Regional Hospital was closed.

What is the total value of Mr. Phelps' compensaton package?

Also this article presented both sides of the arguent, so why is a second article presenting BHS' side being offered?